Healthcare Provider Details

I. General information

NPI: 1184736514
Provider Name (Legal Business Name): RICHARD M ELLERKMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 YORK ROAD LUTHERVILLE PERSONAL PHYSICIANS
LUTHERVILLE MD
21093
US

IV. Provider business mailing address

PO BOX 824173
PHILADELPHIA PA
19182-4173
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberD0053101
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD53101
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: